Modifiable Risk Factors Hypertension Research Articles

Dietary sodium intake and atrial myopathy

Abstract Background Diagnostic markers associated with atrial cardiomyopathy, a precursor state to atrial fibrillation (AF), include premature atrial complex (PACs) frequency, left atrial volume index (LAVi) and p-wave indices. Life-style factors associated with atrial myopathy markers are insufficiently studied. Sodium intake is a modifiable risk factor for hypertension, cardiovascular disease and AF. Purpose We aimed to study the association between sodium intake and atrial myopathy markers in the population-based multicenter Swedish CArdioPulmonary bioImage Study. Methods We included 5,309 randomly invited 50–65-year-olds at the Malmö (n=1,125,) and Uppsala sites (n=4,184) without AF who had contributed a 24hECG and a fasting morning urine sample, from which daily sodium intake was estimated using the Kawasaki formula. At the Malmö site resting ECGs from which P-wave indices could be measured were available in 1,066 individuals, and LAVi was available in a random subsample (n=357). The association between sodium intake and atrial myopathy markers was modeled adjusted for age, sex, body mass index, smoking, systolic blood pressure, antihypertensive treatment, coronary artery disease, and heart failure using negative binomial regression for PAC frequency, linear regression for P-wave duration and LAVi and logistic regression for P-wave terminal force in V1, all using sodium intake as a continuous variable and strata at <2, 2.0-2.99g, 3.0-3.99g, 4.0-4.99g and ≥5 g/day, with 3.0-3.99 as the reference category. We also modeled the association between sodium intake and PACs using restricted cubic splines. Results The mean age was 58.1 (±4.1) years, and 52.7% were female. The mean estimated sodium intake was 3.3 (±1.4) g/day. Mean 24h PAC count was 27, 4.7% had ≥500 PACs. High sodium intakes were associated with increased PAC frequency, of 14% (95% confidence interval (CI 1-29% p=0.03)) for 4.0-4.99g/day and 25% (95%CI 8-45%, p=0.002) for intakes ≥5.0g/day, compared to sodium intakes of 3.0-3.99 g/day. There was no significant association between low sodium intakes (<3.0 g/day) and PACs, Figure 1. Sodium intakes of 4.0-4.99 g/day were associated with increased P-wave duration, ß-coefficient 2.4 (95%CI 0.3-4.1, p=0.03), compared to 3.0-3.99g/day, but there was no association between sodium intakes and LAVi, or P-wave terminal force in V1, either as a continuous variable or in strata. Conclusion High dietary sodium intake is associated with PAC frequency, a known prediction of AF and stroke. Whether reduced sodium diets could reduce PAC frequency, and whether that would impact AF and stroke risk needs further study.Sodium intake and PAC frequency

Assessing Sodium Intake in Middle-Aged and Older Adults with Elevated Blood Pressure: Validation of Spot Urine Excretion and Dietary Survey-Derived Estimates.

This cross-sectional study evaluated the validity of three alternative methods compared to the gold standard 24-h urine collection for estimating dietary sodium intake, a modifiable risk factor for hypertension, among middle-aged and older adults with elevated blood pressure. These included spot urine collection (using Kawasaki, Tanaka, and INTERSALT equations), 24-h dietary recall, and food frequency questionnaire responses, compared to 24-h urine collection in a subset of 65 participants (aged 50-75 years, 58.5% women, 61.6% hypertensive) from the DePEC-Nutrition trial. The validity of the methods was assessed using bias, the Spearman correlation coefficient (SCC), the intraclass correlation coefficient (ICC), and Bland-Altman analysis. Among the alternative methods, spot urine collection using the Kawasaki equation showed the strongest correlation (SCC 0.238; ICC 0.119, 95% CI -0.079 to 0.323), but it exhibited a significant bias (1414 mg/day, p-value < 0.001) relative to 24-h urine collection. Conversely, dietary surveys had a smaller bias but wider limits of agreement. These findings underscore the complexities of accurately estimating dietary sodium intake using spot urine collection or dietary surveys in this specific population, suggesting that a combination or the refinement of existing methodologies might improve accuracy. Further research with larger samples is necessary to develop more reliable methods for assessing sodium intake in this high-risk group.

Assessment of risk factors for hypertension among undergraduate students in a medical college of Himachal Pradesh, India

Background: Hypertension is a commonest cardiovascular disorder and is major cause of premature death worldwide. An estimated 1.28 billion adults aged 30-79 years worldwide have hypertension, most (two-thirds) living in low and middle-income countries. So present study was undertaken to assess the risk factors for hypertension among First year MBBS students so that suitable preventive measures may be undertaken. Methods: It is cross sectional study conducted among first year MBBS students in DRKGMC Hamirpur. The duration of study is three months. The tools of study used were modified structured pretested self-administered questionnaire; WHO stepwise approach to chronic disease risk factor surveillance (STEPS). Weighing machine, measuring tape, digital BP apparatus and steadiometer. Results: A total of 115 students of MBBS first year participated in the study. There were a total of 31.3% (36) boys and 68.7% (79) girls. Thirty three percent (38) had a family history of hypertension. 16.52% (19) had a BMI more than the normal. Among the study participants only 5 students (4.35%) used to consume alcohol and smoke cigarettes. Most of study participants consume fast food and junk food. Conclusions: High prevalence of different modifiable risk factors for hypertension revealed among the study subjects.There is need to screen the modifiable risk factors from very early age.

Association between joint physical activity and healthy dietary patterns and hypertension in US adults: cross-sectional NHANES study

BackgroundLack of physical activity (PA), poor dietary habits, or other unhealthy lifestyle behaviors are potential modifiable risk factors for hypertension. It has been sufficiently demonstrated in previous studies that physical activity or healthy dietary patterns can reduce the risk of hypertension. However, no research focused on the joint effects of PA and healthy dietary patterns on hypertension in a representative sample of adults.MethodsWe used data collected from the 2007–2018 National Health and Nutrition Examination Survey. Healthy dietary patterns were assessed with the Healthy Eating Index 2015 (HEI-2015), and PA was measured using the metabolic equivalent minutes per week reported in questionnaires. We created four lifestyle categories based on the HEI-2015 and PA: (1) unhealthy diet and physically inactive (less than recommended PA), (2) healthy diet but physically inactive, (3) unhealthy diet but physically active (recommended PA), (4) healthy diet and physically active. Logistic regression was used to evaluate the association between joint PA and HEI-2015 and hypertension.ResultsA total of 24,453 participants were enrolled in the study. Compared with unhealthy diet and physically inactive individuals, only healthy diet and physically active participants (adjusted odds ratio [AOR]: 0.77, 95% CI 0.65–0.9) were negatively associated with hypertension, while healthy diet but physically inactive participants (AOR: 0.89, 95% CI 0.76–1.03) and unhealthy diet but physically active participants (AOR: 0.9, 95% CI 0.76–1.06) were not associated with hypertension.ConclusionIn a representative sample of US adults, our findings suggest that individuals with recommended PA and healthy dietary patterns have a lower risk of hypertension than those with an unhealthy diet or less than recommended PA. Healthy eating habits and regular PA are potential preventive precautions against hypertension.

Gender differences in the association between healthy eating index-2015 and hypertension in the US population: evidence from NHANES 1999–2018

BackgroundDiet has long been recognized as an important modifiable risk factor for hypertension. Herein, our research goal was to decipher the association of healthy eating index-2015 (HEI-2015) with hypertension, and to explore potential gender differences.MethodsWe collected the cross-sectional data of 42,391 participants of the National Health and Nutrition Examination Survey (NHANES) 1999–2018. The association of HEI-2015 with hypertension was estimated using weighted multivariate logistic regression, with restricted cubic spline (RCS) regression being adopted to examine the nonlinearity of this association in both genders, and the stability of the results were examined by sensitivity analysis. We also performed subgroup analysis to detect potential difference in the link between HEI-2015 and hypertension stratified by several confounding factors.ResultsAfter eliminating potential confounding bias, the adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for hypertension across higher HEI-2015 quartiles were 0.93 (0.85–1.03), 0.84 (0.77–0.93), and 0.78 (0.72–0.86) compared to the lowest quartile, respectively. HEI-2015 was nonlinearly and inversely associated with hypertension in all participants. The gender-specific RCS curves presented a U-shaped correlation in males, while showed a linear and inverse correlation in females. Besides, subgroup analyses showed a lower risk of hypertension in participants who were females, younger than 40 years, Whites, obese, and diabetic patients.ConclusionsWe determined a nonlinear and inverse association between HEI-2015 and hypertension in the US general population, and revealed a remarkable gender difference when adhering to a HEI-2015 diet for preventing hypertension.

Hypertension: risk perception and health seeking behaviour of long-distance drivers in Port Harcourt.

Driving as an occupation is associated with the occurrence of heart-related diseases such as hypertension. To assess the perception of modifiable risk factors of hypertension and the health seeking behaviour of long-distance commercial bus drivers in Port Harcourt Metropolis. A cross-sectional study design was used to obtain data from 272 long distance commercial drivers. Data were analysed descriptively using SPSS version 24.0. (p≤0.05). A total of 272 questionnaires were completed and returned (100%). Respondents' mean age was 43.4 ± 8.9. In scoring for perception of modifiable risk factors of hypertension among the drivers, (45.6%) respondents had a high perception score while 148 (54.4%) respondents had a low perception score. In assessing for health seeking behaviour, 190 (69.9%) had checked their blood pressure at least once in their lifetime, 80 (42.1%) of those who had checked, did so over a year ago. However, 18 (9.5%) respondents were on medication for hypertension in the last one month. This study showed that a greater number of the drivers had a low perception of modifiable risk factors of hypertension. Regular health checks were also not observed among participants. There is need for targeted health education for this group.

High Risk of Obstructive Sleep Apnea Among Hypertensive Patients at a Selected Tertiary Care Hospital

Introduction: Obstructive sleep apnea (OSA) is a sleep-related breathing disorder characterized by partial or complete obstruction of the upper airway, which causes desaturations and arousal. Various studies have shown that OSA is a major modifiable risk factor for hypertension. Untreated OSA is increasingly associated with cardiovascular and neurocognitive sequela. Thus, our study aims to determine the high-risk of obstructive sleep apnea among hypertensive patients at a tertiary care hospital in Malaysia. Methods: A cross-sectional study was conducted among hypertensive patients at a tertiary hospital in Malaysia. A validated Malay version of the Berlin Questionnaire was utilized along with other questions on sociodemographic characteristics and diabetes mellitus. Results: A total of 161 respondents were involved in the study. The mean age was 48.35 years and among these 75% were males and 25 % were females. The majority of respondents were of Malay ethnicity (78%), followed by Chinese (11%) and Indians (10%). Of these,18 % comprised of obese patients and 29.8% had diabetes mellitus. The prevalence of high-risk OSA among hypertensive patients was 18.0% (95% CI). High risk of OSA was found to be prevalent in the elderly age group (p&lt;0.001), female gender (p&lt;0.001), Indian ethnicity (p&lt;0.001) and among diabetes mellitus patients (p&lt;0.001). Conclusion: The study results illustrate the high risk of OSA among hypertensive patients with advancing age and diabetes mellitus. This study finding mandates these high-risk hypertensive patients should be screened for early diagnosis and timely treatment of OSA to prevent further cardiovascular risk, morbidity and mortality.

Analisis Unmodifiable dan Modifiable Risk Factors Terhadap Kejadian Hipertensi Pada Lansia di Puskesmas Tungoi

Hypertension is a degenerative disease usually referred to as the silent killer because sufferers do not know they have hypertension or do not know before checking their blood pressure. The aim of this study was to analyze the non-modifiable and modifiable risk factors for hypertension. The research design used by a Cross-Sectional Study . The sample obtained in this study was 68 people taken by total sampling technique. The analyzed to measure the relationship between unmodifiable and modifiable risk factor variables on the incidence of hypertension is the chi-square test. The results obtained for unmodifiable risk factors are age (0.002) and heredity (0.014) while the modifiable risk factors are stress (0.003), obesity (0.003), and sodium consumption (0.003) which are associated with the incidence of hypertension. Age and heredity factors cannot be avoided in the risk of hypertension so that hypertension can be controlled with modifiable risk factors such as-avoiding stress and doing lots of physical activity and sedentary behavior can be reduced.

Identifying healthy individuals with Alzheimer’s disease neuroimaging phenotypes in the UK Biobank

BackgroundIdentifying prediagnostic neurodegenerative disease is a critical issue in neurodegenerative disease research, and Alzheimer’s disease (AD) in particular, to identify populations suitable for preventive and early disease-modifying trials. Evidence from genetic and other studies suggests the neurodegeneration of Alzheimer’s disease measured by brain atrophy starts many years before diagnosis, but it is unclear whether these changes can be used to reliably detect prediagnostic sporadic disease.MethodsWe trained a Bayesian machine learning neural network model to generate a neuroimaging phenotype and AD score representing the probability of AD using structural MRI data in the Alzheimer’s Disease Neuroimaging Initiative (ADNI) Cohort (cut-off 0.5, AUC 0.92, PPV 0.90, NPV 0.93). We go on to validate the model in an independent real-world dataset of the National Alzheimer’s Coordinating Centre (AUC 0.74, PPV 0.65, NPV 0.80) and demonstrate the correlation of the AD-score with cognitive scores in those with an AD-score above 0.5. We then apply the model to a healthy population in the UK Biobank study to identify a cohort at risk for Alzheimer’s disease.ResultsWe show that the cohort with a neuroimaging Alzheimer’s phenotype has a cognitive profile in keeping with Alzheimer’s disease, with strong evidence for poorer fluid intelligence, and some evidence of poorer numeric memory, reaction time, working memory, and prospective memory. We found some evidence in the AD-score positive cohort for modifiable risk factors of hypertension and smoking.ConclusionsThis approach demonstrates the feasibility of using AI methods to identify a potentially prediagnostic population at high risk for developing sporadic Alzheimer’s disease.

SYMPTOMS OF POST-TRAUMATIC STRESS PARTIALLY MEDIATE THE RELATIONSHIP BETWEEN GENDER-BASED VIOLENCE AND ALCOHOL MISUSE AMONG SOUTH AFRICAN WOMEN

Objective: Alcohol misuse is among modifiable risk factors of hypertension and cardiovascular diseases. Previous studies have described the associations of a range of traumatic experiences with problematic alcohol use, but data on possible mediation effects of mental distress are sparse. We examined whether mental ill-health mediated the association between trauma exposure across the lifespan and alcohol misuse. Design and method: We analysed cross-sectional data from a pooled sample of rape-exposed and non-rape-exposed women, 18-40 years-old, living in KwaZulu-Natal, with self-reported data on alcohol misuse (Audit-C cut-off = &gt;3) and exposure to childhood maltreatment (CM), intimate partner violence (IPV), non-partner sexual violence (NPSV), other traumatic events, and mental ill-health including depression, post-traumatic stress symptoms (PTSS). Logistic regression and multiple mediation models were used to test the mediation effects of symptoms of depression and PTSS on the association between abuse/trauma and alcohol misuse. Results: Of 1615 women, 31% (n = 498) reported alcohol misuse. Exposure to any CM (adjusted odds ratio (OR): 1.59, 95% confidence interval (CI): 1.27-1.99), sexual (OR: 1.24, 95%CI: 1.04-1.94), physical (OR:1.39, 95%CI:1.12-1.72) and emotional CM (CA) (OR: 1.31, 95%CI: 1.04-1.66) were independently associated with alcohol misuse. Lifetime exposures to any IPV (OR:2.01, 95%CI:1.59-2.54), physical (OR:2.15, 95%CI:1.72-2.69), emotional (OR:1.61, 95%CI: 1.30-2.01) and economic IPV (OR: 1.35, 95%CI: 1.03-1.78), NPSV (OR: 1.75, 95%CI: 1.32-2.33) and other trauma (OR:2.08, 95%CI:1.62-2.66) were associated with alcohol misuse. Parental neglect and sexual IPV were not associated with alcohol misuse. Exposure to an increasing number of abuse types, and severity of CM (overall, physical and emotional, and parental neglect), IPV (overall, physical and emotional), NPSV and other traumatic events were independently associated with alcohol misuse. PTSS partially mediated the associations of CM, IPV, NPSV and other trauma exposures with alcohol misuse (p-values&lt; = 0.04 for indirect effects), but depression symptoms did not. Conclusions: These findings highlight the need for trauma-informed psychological interventions to prevent and reduce alcohol misuse in women exposed to violence. Women diagnosed with alcohol misuse should be screened for trauma exposures and provided appropriately care, treatment.

Trends in Modifiable Risk Factors Amongst First Presentation ST Elevation Myocardial Infarction Patients in a Large Longitudinal Registry.

Recent studies suggest that the risk factor profile of patients presenting with ST elevation myocardial infarction (STEMI) is changing. The aim is to determine if there has been a shift of cardiovascular risk factors to cardiometabolic causes in the first presentation STEMI population. We analysed data from a STEMI registry from a large tertiary referral percutaneous coronary intervention centre to determine the prevalence and trends of the modifiable risk factors of hypertension, diabetes, smoking and hypercholesterolaemia. Consecutive first presentation STEMI patients between January 2006 to December2018. Among the 2,366 patients included (mean age 59, SD 12.66, 80% male) the common risk factors were hypertension (47%), hypercholesterolaemia (47%) current smoking (42%) and diabetes (27%). Over the 13 years, patients with diabetes (20% to 26%, OR 1.09 per year, CI 1.06-1.11, p<0.001) and patients with no modifiable risk factors increased (9% to 17%, OR 1.08, CI 1.04-1.11, p<0.001). Concurrently there was a fall in prevalence of hypercholesterolaemia, (47% to 37%, OR 0.94 per year, CI 0.92-0.96, p<0.001) and smoking (44% to 41%, OR 0.94, CI 0.92-0.96, p<0.001) but no significant change in rates of hypertension (53% to 49%, OR 0.99, CI 0.97-1.01, p=0.25). The risk factor profile of first presentation STEMI has changed over time with a reduction in smoking and a concurrent rise in patients with no traditional risk factors. This suggests the mechanism of STEMI may be changing and further investigation of potential causal factors is warranted for the prevention and management of cardiovascular disease.

63. Effect of Physical Activity on Hypertension in the Geriatric Population at Cawang, East Jakarta

Background: Geriatric population has a high risk for hypertension, mainly as the result of arterial stiffening caused by aging. Indonesia's RISKESDAS in 2018 shows that the prevalence of hypertension is rising with age. Lifestyle factors such as physical inactivity are one of the modifiable risk factors for hypertension. Regular exercise can reduce the stiffness of blood vessels and increase the endurance of the heart and lungs so that it can lower blood pressure. Objectives: This study aims of this study is to investigate the effect of physical activity on hypertension in the geriatric population in Cawang, East Jakarta. Methods: The research design used a quantitative cross-sectional research method with a random sampling technique and using the Chi-Square method to analyze the correlation between physical activity and blood pressure in the geriatric population. Blood pressure data were obtained using sphygmomanometer and hypertension criteria based on JNC VIII. Physical activity based on International Physical Activity Questionnaire. Results: In this study, 65 research samples were obtained that met the inclusion criteria in Cawang, East Jakarta. The amount of hypertension cases account for 78.5 percent of the people. Low physical activity was identified through 37 people (55.4%), moderate physical activity was identified through 9 people (17,6%), and high physical activity was identified through 5 people (10.8%). The result of the study found that there is a correlation between physical activity and the incidence of hypertension (p = 0.001). Conclusion: There is a correlation between physical activity and the incidence of hypertension.

Estimation of Salt Intake in Normotensive and Hypertensive Children: The Role of Body Weight.

The connection between increased dietary salt intake and arterial hypertension has been recognized for a long time, even in children. This study aimed to investigate salt consumption in normotensive and hypertensive children and evaluate their dietary habits. A total of fifty participants were included in this cross-sectional study: twenty-five normotensive children and 25 children of both sexes with essential arterial hypertension from 12-17 years old. Subjects' body mass index, waist-to-hip ratio, body composition and arterial blood pressure were measured, and their daily salt intake was calculated from 24-h urine samples. Using the food frequency questionnaire (FFQ), the data on the average daily total energy and food intakes were collected and analyzed using a suitable program. Estimated daily salt intake was significantly higher in hypertensive compared to normotensive children, and this is positively associated with blood pressure and body mass index (BMI). Hypertensive children had significantly higher BMIs, which also positively correlated with blood pressure. Consistently, resting metabolic rate (kcal) is higher in hypertensive children compared to normotensive, and this is also associated with blood pressure. Reported energy intake is also enlarged in hypertensive compared to normotensive children and for both groups, levels are significantly higher than the recommended values. Our study results confirm the relationship between daily salt consumption, blood pressure and body weight. Sodium consumption related to blood pressure and body weight among children. Cardiovascular disease prevention should start in early childhood by reducing salt intake and preventing overweight/obesity since these are two of the most important modifiable risk factors for hypertension.

Identification of Hypertension Risk Factor at Tarowang Village, Takalar, Indonesia

The prevalence of hypertension is increasing in the world and in Indonesia. The disease, known as the silent disease, is experienced by many people, but diagnosed too late. As a result, the impact is much greater, namely death from heart disease and stroke. Lifestyle and food intake are modifiable risk factors for hypertension. In addition, gender, age, and genetic history are risk factors that cannot be changed, but by identifying them, it can increase awareness to avoid other risk factors. This study aimed to identify risk factors for hypertension in Tarowang Village. This research was conducted with a cross-sectional study design, total sample was 116 people chosen by purposive sampling method. Hypertension defined using JNC 7 category and measured by ABN Spectrum Aneroid Sphygmomanometer. The results of this study indicate that the prevalence of hypertension was 18.97%. Age and nutritional status have significant relationship with hypertension (0.004 and 0.021, respectively). The variable consumption of vegetables and fruits, although it did not show a significant relationship, the hypertension proportion was still higher in respondents who did not eat vegetables and fruit every day. Promoting healthy behavior was needed to prevent increasing hypertension prevalence. Implementation from nutrition guidelines such as maintaining weight, increasing fruit and vegetable consumption were important in Tarowang Village.

Occupational risk factors for hypertension.

The identification and characterization of the modifiable risk factors of hypertension is of great value for public health and clinical medicine to achieve primary prevention. A large amount of literature on the effects of occupational factors on blood pressure and hypertension has been published. In this review, I summarize current evidence regarding the role of occupational factors in hypertension. The results of this review suggest that there is sufficient evidence to support the association between increased risk of hypertension and job stress, shift work, occupational lead exposure, and noise exposure. The association of hypertension with physical inactivity, sedentary behavior, and occupational exposure to mercury, arsenic, cadmium, or carbon disulfide remains inconclusive, although several studies have reported this finding. This review will serve as a step toward future research and provide baseline information for developing strategic interventions to prevent hypertension in the working population.

Evaluating the safety and efficacy of a polyherbal Unani formulation in dyslipidaemia-a prospective randomized controlled trial

Ethnopharmacological relevanceUnani System of Medicine offers treatment for obesity and dyslipidaemia. Jawarish Falafili (JF) is a Unani polyherbal pharmacopoeial preparation. It has been used in the treatment of obesity for a long time. Dyslipidaemia is a recognised modifiable risk factor for hypertension, ischemic heart disease and stroke. Limitations of the current conventional therapy have provided scope for research of a potential drug in this medical condition. It was hypothesised that JF may ameliorate dyslipidaemia in human participants.Aim of the study: The main objective of this study was to evaluate the safety and efficacy of the JF. Materials and methodsThis was a prospective randomized, active-controlled, open-label and parallel-group study. We randomized 74 participants of dyslipidaemia into treatment (n = 38) and control (n = 36) groups. Of them, 30 participants in each group completed the trial. The participants of any sex aged between 30 and 60 years, with serum total cholesterol (TC) ≥200 mg/dl and/or serum triglycerides (TG) ≥150 mg/dl and/or low-density lipoprotein cholesterol (LDL-C) level ≥130 mg/dl and/or high-density lipoprotein cholesterol (HDL-C) level <40 mg/dl were enrolled in this study. The participants of the treatment group were treated with JF (10 gm/day) once and atorvastatin (20 mg/day) was given to the control group for 90 days once at night daily. ResultsWe observed a significant reduction (treatment group versus control group) in mean serum TC by 22.89% versus 19.36%, TG by 29.90% versus 23.26% and LDL-C by 29.16% versus 27.92% from baseline (p < 0.05). But the change in mean serum HDL-C levels post-treatment was insignificant in both groups (p > 0.05). On intergroup comparison, the magnitude of the difference of mean TC, TG, LDL-C and HDL-C levels between the groups was not statistically significant (p > 0.00.05). ConclusionsThis study concluded that JF and atorvastatin were equally effective in controlling dyslipidaemia. They were tolerated well by all participants and found safe during the course of treatment.

Tobacco smoking and blood pressure: How are they related among the Indians? - A secondary analysis of National Family Health Survey (NFHS)-4 data.

India, the second leading producer of tobacco, puts the population at a higher chance of tobacco consumption contributing to a significant disease burden. Though tobacco smoking is a modifiable risk factor for hypertension and has been on the rise among the population, studies on the relationship of tobacco with hypertension are limited in India. This study aimed to assess the population-level risk of tobacco (smoke) use and elevated blood pressure (BP) among Indians and also assess the association of risk of tobacco smoking with hypertension based on the place of residence. Data from the National Family Health Survey (NFHS)-4 conducted between January 2015 and December 2016 was utilized. The prevalence of hypertension and its magnitude of association with smoking factors was found using univariable logistic regression. Multivariable logistic regression was performed to predict the association of smoking products with elevated BP by adjusting the model for sociodemographic factors, illness, physical characteristics, and state-wise data. The weighted prevalence of hypertension was 16.56% (confidence interval [CI]: 16.34-16.78) in males and 11.20% (CI: 11.12-11.27) in females. Among those who smoked tobacco, 15.3% women and 22.4% men were hypertensive. This study highlights the significant association of smoking of various tobacco products with hypertension in both men and women on univariate analysis. But the adjusted mean elevated BP among the tobacco-using males and females was not significantly associated with smoking cigarettes, pipe, cigars, and hookah. Cigarette smoking is a modifiable factor for the development and progression of hypertension. Adequate preventive and promotive health measures targeting the young, rural inhabitants and the poorer sections of society may help in reducing tobacco consumption.

Healthy Food Environments in Food Pantries: Lessons Learned from a Sodium Reduction Intervention.

In the United States, food pantries increasingly serve as regular food sources for low income households experiencing high rates of chronic disease, including hypertension. Sodium consumption is a modifiable risk factor for hypertension, so pantry customers would benefit from access to low-sodium foods. Pantry customers often experience difficulty acquiring healthy foods, however; little is known about pantry foods’ sodium content specifically. This study assesses the sodium content of pantry foods and lessons learned from an adaptable intervention to support pantries in adopting policies and environmental changes to make healthy, lower-sodium foods appealing and accessible. We conducted sodium assessments of food at 13 food pantries, tracked implementation of intervention strategies, and interviewed 10 pantry directors. More than half of food items in 11 categories met sodium standards for foods to be chosen “often”. Pantry directors reported valuing the intervention approach and implemented six of nine behavioral economics strategies, especially those targeting the visibility and convenience of foods, along with layout changes and expanded customer choice. One pantry adopted an agency-specific nutrition policy and 12 adopted a coalition-level policy. Results can inform intervention efforts to make available healthy options appealing and easy to select while also improving the customer experience in food pantries.

Hypertension Management in Primary Health Care Centres: Blood Pressure Control and Classes of Antihypertensive Medication, Khartoum State, 2018

Background In Sudan, the delivery of care based on the primary health care (PHC) level, which is the first contact with the health system. PHC is the level at which the modifiable risk factors for hypertension are addressed together with the treatment of known hypertensive patients. Objective To assess the management of hypertension in PHC in Khartoum State, 2018. Material and Methods The study was a descriptive cross-section, health centre’s based that covered six PHC centres in Khartoum State. The study interviewed all diagnosed Sudanese hypertensive patients more than 18-years of age who attended the selected PHC centres. The research team collected data using a structured questionnaire and measuring the blood pressure (BP) with a mercury sphygmomanometer. The study variables were demographic characteristics and disease features as independent variables and hypertension control as the dependent variable. The statistician analyzed the data using the statistical package for the Social Science version 21.0 and the Chi-square (χ) test to obtain the p value to test the association between the addressed variables. The study group adopt ethical considerations throughout the study. Results Of the 384 hypertensive patients interviewed in this study, 57% were females and 47.7% were more than 60-years of age. A large percent of the subjects were either primary educated or illiterate (32.6%, 19.8% respectively). More than half of the hypertensive patients (52.1%) were uncontrolled and 52.9% had no comorbidities. Diabetes was predominant (39.3%) among those who had comorbidities. The majority of the patients (92.7%) were adherent to the medication. Of the studied patients, 58.1% used monotherapy. The most controlled patients were the elderly and middle-aged patients and the highly educated patients (p=0.005). Patients with a duration less than five-years were more likely to be controlled (p=0.036). The majority of the patients who used combined treatment were found to be controlled. Conclusion This study concluded that the high prevalence of uncontrolled hypertensive patients attending PHC was mainly attributed to the use of monotherapy, presence of comorbidities and medication non-adherence. The latter is related to patients’ ignorance, financial constraints and dislike of using many drugs during the day. In addition, the use of combined therapy, elder age and high education were factors for better control.

How Does Being Overweight Moderate Associations between Diet and Blood Pressure in Male Adolescents?

Diet is one of the strongest modifiable risk factors for hypertension. In this study, we described the associations between dietary factors and blood pressure; and explored how weight status moderated these associations in a sample of New Zealand male adolescents. We collected demographics information, anthropometric, blood pressure, and dietary data from 108 male adolescents (15–17 years old). Mixed effects and logistic regression models were used to estimate relationships between dietary variables, blood pressure, and hypertension. Moderation effects of overweight status on the relationship between hypertension and diet were explored through forest plots. One-third (36%) of the sample was classified as hypertensive. Fruit intake was related to significantly lower systolic (−2.4 mmHg, p = 0.005) and diastolic blood pressure (−3.9 mmHg, p = 0.001). Vegetable and milk intake was related to significantly lower diastolic blood pressure (−1.4 mmHg, p = 0.047) and (−2.2 mmHg, p = 0.003), respectively. In overweight participants, greater vegetable and milk, and lower meat intake appeared to reduce the odds of hypertension. Certain dietary factors may have more prominent effects on blood pressure depending on weight status.